Evidence-Based Medicine Analysis of Isthmic Spondylolisthesis Treatment Including Reduction Versus Fusion In Situ for High-Grade Slips

In Brief Study Design. Literature review. Objectives. The purpose of this article is to review the available literature and to attempt to formulate evidence-based recommendations for the surgical treatment of high-grade spondylolisthesis in the pediatric population. Summary of Background Data. The surgical management of high-grade spondylolisthesis remains controversial due to the lack of high level evidence. Prospective randomized studies have not been completed. Methods. Through an electronic database search and published literature cross-reference, appropriate studies were identified and assigned the appropriate level of evidence. Results. There were no Level I or II evidence on this topic with our search. The best level of evidence that we have on this topic is retrospective comparative studies. We found 5 such articles which compared fusion in situ to reduction and fusion for high-grade spondylolisthesis. Pseudarthrosis rates are decreased by performing an instrumented reduction with a fusion. However, there is no significant difference in a clinical outcome of patients treated in situ versus reduction. Conclusion. Because of the paucity of high levels of evidence, we are not able to formulate clear guidelines for treatment of high-grade spondylolisthesis based on the best evidence available in the published literature. While searching for the best evidence-based articles on the surgical management of high-grade spondylolisthesis, we found 5 retrospective comparative studies comparing fusion in situ to reduction and fusion. Pseudarthrosis rates are decreased by performing an instrumented reduction and fusion, although no significant difference in the clinical outcomes was found.